RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-02734
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050629

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Signal Support System Specialist, medically separated for “chronic right knee pain” with a disability rating of 0%. “Bilateral foot pain” was determined to have existed prior to service (EPTS) and was not rated.

CI CONTENTION: Review requested of the knee condition as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in DoDI 6040.44. It is limited to review of disability ratings assigned to those conditions determined by the PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB to be not unfitting or non-compensable. Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation. The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws. The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20050622	VARD - 20060117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Patellofemoral Pain Syndrome, Right Knee with Mild Degenerative Changes	5099-5010	10%	20050819	
Chronic Left Knee Pain	Not Unfitting					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Chronic Right Knee Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed bilateral knee pain in 2003 after initially reporting only right knee pain. Knee X-rays were normal and he was diagnosed with bilateral patellofemoral syndrome. Despite some improvement with physical therapy (PT), he continued to have anterior knee  pain. The  29  March  2005  MEB  PT  range  of  motion  (ROM)  study,  3  months  prior  to

separation, revealed right knee flexion to 115 degrees (normal 140) and extension to 0 degrees (normal), after repetition and limited by pain. The 26 April 2005 MEB NARSUM examination, 2 months before separation, noted CI complaints of bilateral knee pain. On physical examination, there was knee joint tenderness but no pain with patellar apprehension testing. Right knee pain was elicited with flexion, and mild crepitation was noted, but there was no instability or meniscal injury.

At the 19 August 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported progressively worsening knee pain. Physical examination showed a normal gait, and no muscle spasm, tenderness, or laxity. Right knee ROM after repetition showed flexion to 95 degrees and extension to 10 degrees, with painful motion. There was no additional loss of motion due to pain, fatigue, weakness or lack of endurance. Bilateral knee X-rays showed fluid in the suprapatellar bursa and mild degenerative changes, greater on the right than the left.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing no joint laxity and normal X-rays. The VA rated the right knee condition 10%, analogously coded 5099-5010 (arthritis, due to trauma), based on the C&P examination, citing pain and mild degenerative changes. Panel members agreed there was evidence of painful motion with functional loss during all the examinations for a 10% rating (based on §4.59, §4.40 and §4.45). However, there was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); history of surgery to remove a meniscus (5259); and no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262). There was therefore no rating higher than a 10% supported by any applicable VASRD code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5099-5003.

Contended PEB Condition: Chronic Left Knee Pain. The panel’s main charge is to assess the fairness of the PEB determination that the contended left knee condition was not unfitting. The left knee condition was profiled along with the right knee as a bilateral knee injury, and both knees were implicated in the commander’s statement and failed retention standards. Treatment visits were documented in the STR, and the CI reported bilateral knee pain which was treated by physical therapy. The panel concluded there was a preponderance of evidence that the left knee condition was separately unfitting and eligible for service disability rating. As mentioned above, CI’s bilateral knee pain began insidiously, first in the right, then in the left knee, and he was diagnosed with patellofemoral syndrome. Treatment improved symptoms, but did not resolve his knee pain. At the MEB PT ROM study, left knee flexion, after repetition, was 130 degrees and extension was 0 degrees with motion limited by pain. The MEB NARSUM examination noted complaints of bilateral knee pain, and the examiner noted knee joint tenderness with mild crepitation. Left knee pain was elicited with flexion, and there was pain with patellar apprehension testing.  There was no evidence of instability or meniscal injury.

At the C&P examination, the CI reported that his left knee became painful after compensating for his right knee injury as discussed above. Physical examination showed a normal gait, and no muscle spasm, tenderness, or no joint laxity. Left knee range of motion (ROM) following repetition revealed flexion of 95 degrees (normal 140) and lack of full extension of 10 degrees (normal 0), with painful motion. There was no additional loss of motion due to pain, fatigue, weakness or lack of endurance. Bilateral knee X-rays showed fluid in the suprapatellar bursa and mild degenerative changes, greater on the right than the left. The VA rated the knee condition 10%, analogously coded 5099-5010 (arthritis, due to trauma), based on the C&P examination, citing functional loss due to pain IAW §4.40 and §4.45, and members agreed this rating was supported by evidence of painful motion documented at all the examinations. Alternatively, a 10% rating was warranted for extension limited by 10 degrees under code 5261 (limitation of leg

extension), as recorded at the VA examination. There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); history of surgery to remove a meniscus (5259); or fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262). There was therefore, no rating higher than a 10% rating supported with any applicable VASRD §4.71a code. After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of left knee condition favors its recommendation as an additionally unfitting condition for disability rating. It is appropriately coded 5099-5003 and meets the VASRD §4.71a criteria for a 10% rating.

BOARD FINDINGS: In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. In the matter of the contended left knee condition, the panel agrees it was unfitting and recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain	5099-5003	10%	
Chronic Left Knee Pain	5099-5003	10%	
	COMBINED	20%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170307, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190008408, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.